Monday, June 10, 2019

A Challenge

“Bipolar Disorder can be a great teacher. It’s a challenge, but it can set you up to be able to do almost anything else in your life.” (Carrie Fisher)

Bipolar Disorder (BD) is sometimes referred to by its older clinical name Manic Depression. BD is a mood disorder that greatly interferes with the quality of life for a child or adult. Myths about BD can stand in the way of providing appropriate care for persons who have this condition. One myth is that those with BD should be able to control it by will alone. This falsehood may prevent sufferers from adhering to therapy or from seeking care in the first place.

BD occurs in all races, ethnic groups, and social classes. Although it affects males and females equally, males tend to have an earlier onset. BD reduces life expectancy by 9.2 years, with up to 33% of sufferers attempting suicide and 15% completing it. About 69% of persons with BD are misdiagnosed, delaying proper treatment 5 to 10 years.

The most common misdiagnosis is major depressive disorder—probably because most people with BD seek help when they’re so depressed they can’t function, not when they’re having a manic episode and believe they can accomplish anything. The sixth leading cause of disability in the world, BD is an episodic, chronic illness affecting approximately 5.7 million adult Americans. It’s marked by extreme changes in mood, thought, behavior, and energy level. Mood swings can vary in intensity, length, and the degree to which they interfere with functioning. Severe mood swings can last weeks or months and may severely disrupt the person’s life. Here is what you need to know about BD:

1.   There are three types of BD

·        Bipolar I: This is the diagnosis most of the general public knows. To qualify for this disorder, a child or adult must have a single episode of mania followed by a single episode of depression. Symptoms are very intense and if left untreated often require hospitalization.

·        Bipolar II: Sometimes called Soft Bipolar, Bipolar II involves a less intensive form of mania, called hypomania. To qualify for this disorder, a person has to have a history of experiencing an episode of hypomania and an episode of depression.

 
·        Cyclothymia: People with Cyclothymia experience symptoms of hypomania and symptoms of mild depression. The episodes of Cyclothymia tend to be shorter and less intensive in duration, but are chronically present for at least two years.

2.   Mania: This is an elevated state of mood. There are two kinds of mania one can experience. The type of BD diagnosis will depend on the texture of the mania.

·        Mania: An excitable state where physical hyperactivity, disorganization, decreased need for sleep, impulsivity, emotional reactivity, euphoria, impaired judgment, irritability, racing thoughts, rapid speech, loose associations, grandiose beliefs, and hypersexuality occur.  Mania can also elevate to extreme levels where disorientation, incoherence, delusions, paranoia, and violence erupt. Mania greatly interferes with daily living.

 

·        Hypomania: A condition similar to mania but less severe. The symptoms include elevated mood, increased physical activity, decreased need for sleep, and racing thoughts, but do not cause significant impairment in one's work, school, interpersonal or social interactions.             

3.   Episodes: Children and adults with BD experience unusually intense emotional states that occur in distinct periods called mood episodesAn overly overexcited state is called a manic episode or hypomanic episode, and an extremely sad or hopeless state is called a depressive episode.

4.   Mixed States: Individuals can experience mania/hypomania and depression at the same time. This is called a mixed state. Children and adults in a mixed state may feel very sad or hopeless while also feeling extremely energized.

5.   Cycling: There are two types of mood elevation cycles that individuals who have a type of BD move through.

·        Rapid cycling: This type of cycle includes episodes of mood elevation and depression followed by another cycle of mood elevation and depression four or more times per year.

 
·        Ultrarapid cycling: Unlike rapid cycling — which episodes occur every few months — children and adults can experience abrupt cycling of mania/depression or hypomania/depression weekly or even hourly.

6.   Medication: Scientific research urges medication management as a vital part of treatment of BD. Specifically, use of a mood stabilizer and antidepressant medications are recommended in all phases of treatment for children as well as adults.

7.   Psychotherapy: Along with medication management, psychotherapy is recommended to manage BD. Evidence-based therapies such as Cognitive Behavioral Psychotherapy, Psychodynamic Psychotherapy, Family-Focused Therapy, Interpersonal Psychotherapy, and Psychoeducational Approaches are recommended.

8.   Self-Care: Living with BD requires a child or an adult to manage this chronic illness. Learning how to take care of one's self is important. In addition to eating well, keeping a healthy sleep cycle and exercising, creating time to nurture one's mind body and soul is helpful.

9.   Continuity of Care:  Bipolar Depression is a treatable illness. With proper diagnosis and treatment, people with BD can lead healthy and productive lives. Research reports upwards of 50% of individuals abandon psychotherapy and/or medication. "Feeling better," missing the euphoric highs, or not liking the side effects of medication are often reasons why this happens. As a result, many will experience a worsening of their symptoms and quality of life difficulties will persist. Continuity of care is an important factor in the success of BD and needs to be a priority.

“At times, being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of. They should issue medals along with the steady stream of medication.” (Carrie Fisher)[i]



[i] Sources used:

·        “10 Things to Know About Bipolar Disorder” by Deborah Serani

·        5 things you didn’t know about bipolar disorder and they may surprise you” by Michael Morgan
·        “What you need to know about bipolar disorder” by American Nurse Today
 

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